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Resulting from
1.defects in insulin secretion,
2.Insulin action
3. or both
:Types of DM
1.
2.
3.
4.
Pathophysiology:
Causes:
1.
Genetic ( people Inherit genetic predisposing, or
tendency toward developing type I DM but do not
inherit Type I DM),
2.
Autoimmune response
3.
Environmental Factors
:Continue
Type II: Onset > 30 years
Causes:
1.
Insulin resistance due to obesity
2.
Impaired insulin secretion (but still there is insulin
secretion
3.
Hereditary
Detected incidentally
Clinical manifestations:
Laboratory Examination:
HgbA1c( every 3 months)
Microalbuminuria or 24-hour urine collection ( annually)
Fasting Lipids ( annually)
Management:
Dietary ManagementGoals
Meal Planning
Fiber
Glycemic Index
Alcohol
Reading labels
Exercise
Exercise Precautions
Exercise Recommendations
Monitoring:
1.
Cont.
2.
3.
4.
4. Pharmacological therapy:
I.
:Insulin regimens
1. Conventional regimen: is to simplify the
insulin regimen ( 1-2 injections/day). May
be appropriate for the terminally ill,
unwilling or unable to engage in the selfmanagement activities that are part of
amore complex insulin regimen
2. Intensive regimen: 3-4 injection/day to
achieve as much control over blood glucose
levels as is safe and practical and to
decrease complications
Required actions
Insulin Pump
Cont
Insulin pens
Jet injection: deliver insulin through skin under
pressure( absorbed faster)
Insulin pumps: continuous s/c insulin infusion
Implantable and inhalant insulin Delivery.
Transplantation.
Patient teaching
1.
Used for the treatment for type II Diabetic patients who cant
treated by diet and exercise alone
Cant be used during pregnancy
Are Five groups:
Sulfonylureas:
Action:
- Stimulating the pancreas to secret insulin. Cant be used with
Type I DM
- also improve insulin action at the cellular level.
- May directly decrease glucose production by the liver.
Side effects: GI symptoms, dermatology reactions and
hypoglycemia (most one) specially with delayed food intake or
exercise is increased.
2nd generation of this group have shorter half- life than 1 st
generation which make them safer to use in elderly and even in
adults in regards to hypoglycemia
2. Biguanides:
Metphormin (glucophage).
Action: Facilitating insulins action on peripheral receptors
sites.
Used in combination with Sulfonylureas agent
Side effects: Hypoglycemia, Lactic acidosis is a potential
serious side effect
Contraindicated in patient with renal impairment or at risk for
renal impairment
Nursing measures: renal function should be monitored,
should not be administered 2 days before any diagnostic test
requires use of contrast agent.
Acarbose (Precose)
Action: Delaying absorption of glucose from the intestinal system
resulting in a lower postprandial blood glucose level. Should be taken
immediately before meals.
They are not systemically absorbed.
Side effect: diarrhea and flatulence
4. Thiazolidinedions:
Troglitazone (Rezulin)
Meglitinides:
Repaglinides (Prandin)
Action: stimulate the release of insulin from the pancreas
Has fast action and short duration and should be taken before
each meal.
Side effect: Hypoglycemia
5. Education:
1.
2. Diabetic ketoacidosis
Causes:
Cont
Clinical manifestations:
Blurred vision
Medical management:
1.
2.
blood vessels
Blood vessels walls thicken, sclerose, and become occluded by
plaque ( atherosclerosis).
May happened due to other diseases
Coronary artery disease, Cerebrovascular disease, and
peripheral vascular disease are the three main types of
Macrovascular.
Unique to DM
Capillary basement membrane thickening of the retina
(microangiopathy) and kidneys (Nephropathy)
Proliferative retinopathy is characterized by the proliferation of
new blood vessel of new blood vessels growing out of the retina
into the vitreous which are prone to bleeding.
Cont.
3. Diabetic Neuropathies:
Clinical manifestation:
1.
2.
3.
4.
5.
6.
Diabetic foot:
1.
2.
3.
1.
2.
3.
4.
5.